Healthcare Provider Details

I. General information

NPI: 1003739830
Provider Name (Legal Business Name): STEPHANIE ELIZABETH MAUER DACCHM, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32246 HAWTHORNE CT
AVON LAKE OH
44012-2616
US

IV. Provider business mailing address

32246 HAWTHORNE CT
AVON LAKE OH
44012-2616
US

V. Phone/Fax

Practice location:
  • Phone: 440-522-8839
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number65.000477
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: